Jim Borgstede, MD, on Staffing and Imaging Workload

Jim Borgstede, MD, kicked off this morning's second session on the topic of "Where is the Radiologist?: Radiology's Changing Dynamics." The well attended panel focused on staffing and imaging workloads; Borgstede reported that workloads for radiologists have increased sharply since the early nineties, while payment has begun to level off. Well, no huge shocks there.
According to Borgstede, issues affecting workload today include the number of radiologists, radiologists' credibility with patients, hospital system relationships and more. "My assumptions are that medical imaging will continue to grow," he said. "Hence the reason everyone is interested in our services and trying to control them."
An ACR survey found that the number of mean weekly hours that full-time radiologists work has increased by five hours in twelve years, but there has been a 5% decrease in days worked per year. Is there a radiologist shortage? The ACR's research department, looking at job listings versus job seekers, and found there are not enough jobs per job seeker. "Radiologists are not currently in short supply," he said. "That's good if you're in academic practice, by the way. But I think there will be a shortage of radiologists in the future. This is a cyclical issue." He says progressive groups should hire early, picking up the most promising graduates as quickly as possible to be ready when the economy begins to turn around.
Borgstede also mentioned the credibility radiologists have with patients, colleagues, institutions, payors and the government. "If we don't address this issue, it will be the downfall of our profession," he said. A 2007 ACR survey indicated that only 55% of the lay public knew that a radiologist was a physician. "My inference from this is that many of the lay public believe we are technologists, and that detracts from our stature," he said. Showing a picture of an ATM with a human head, he added, "Is this how we treat our patients? For many of us it is." The solution, according to Borgstede, is developing a "face of radiology" for both patients and clinicians, citing mammography as a subspecialty with a "face."
Regarding hospital system relationships and solutions, Borgstede recommends avoiding staffing models such as closed medical staffs and purchased practices. "When radiologists are employees, there's short term gain, but the only difference between an employee radiologist and the lowest paid hospital employee is the fact that we cost more and are harder to handle," he said. "Exclusive contracts are of little value. They don't protect us from the real threats -- other specialties taking our turf and giving up hospital privileges."
He also touched on the commoditization of the industry. In 2007, more than 50% of practicing radiologists were using after-hours or nighthawk services. "What this does in my opinion is de-links the integrated components of an imaging examination: appropriateness, quality, interpretation and consultation," he said. "With teleradiology, all that's performed is an interpretation." He also warned against a familiar scenario: hospitals teaming up with teleradiology services, then eliminating radiologists. "This isn't theoretical. It's occurring." This leads to commoditization, he says, and once these services become embedded in a practice, it's hard to take them away again.
But that ain't the half of it. With health care reform requiring savings on all sectors of health care, Borgstede foretells a future in which the government might even get onboard with teleradiology services. With $16 billion spent on imaging annually, it’s not too hard to imagine. Borgstede recommends the formation of local academic-private practice alliances to fight this trend. “We should internalize these after-hours services,” he said.
CMS’s final rule for 2010 will impact imaging workloads, Borgstede said, by requiring 90% utilization on diagnostic imaging equipment. All of the final rule’s mandates incentivize hospital imaging over office imaging, and thus incentivize practice consolidation as opposed to the hiring of more radiologists.
“We have to keep patient primacy and patient benefit first,” he said. “We have to be adaptive to change. And we have to develop a long-term rather than a short-tem perspective to the problem of communication.
“We can succumb to the economic pressures, or we can mobilize.”